have been observed for centuries but the term rhinophyma (from the Greek rhis for nose & phyma for growth) was first used in 1845 by Hebra. It was initially thought to be due to chronic alcohol consumption but is currently thought to be a severe form of acne rosacea. There is bulbous enlargement of the nose with a ruddy complexion & numerous pits along the surface. The sebaceous glands of the nose increase in size & number with each surface pit being the mouth of a gland. Although the disease is benign superficial skin infections are characteristic with drainage of foul smelling material. It is 12 times more common in men than women.
In the early stages accutane may help shrink the sebaceous glands but could adversely effect future surgical treatment of the disease. For more marked disease the treatment is full thickness excision with skin grafting or tangential (partial thickness) excision allowing the skin to heal without grafting. Some surgeons prefer laser excision citing less bleeding among other reasons. Having seen & tried various modalities I think tangential excision with a scalpel under local anesthesia is best. The nature of laser excision makes this more difficult with laser which works from the surface downward rather than tangentially. The nose heals within a week or 2 as the surface is repopulated by cells from the depths of all those pits.
Since the disease is not curable control in the early stages or after surgical excision & healing is of paramount importance to prevent recurrence. This involves continued use of oral tetracycline antibiotics at least a few times a week & meticulous skin cleansing. Avoidance of spicy foods, caffeine & alcohol also may help.